Eye Movement Desensitization and Reprocessing (EMDR) is a comprehensive approach that integrates many effective therapies, including CBT, interpersonal, experiential and body-centered, in a structured protocol designed to maximize treatment effects.
EMDR is an information processing therapy that uses an eight phase approach to address a wide range of conditions and complaints. It taps into to the past experiences that have set the groundwork for present-day issues, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experiences needed to enhance future adaptive behaviors and mental health.
During treatment "bilateral stimulation" using either eye movements or taps allows a client to access past memories, present-day triggers, or anticipated future experiences and generate new insight, changes in memories, or new associations as well as a reduction in emotional intensity and a shift to more positive beliefs. Clients are often able to shift out of stuck patterns and achieve relief in a more accelerated timeline that talk therapy alone.
EMDR can be used in the treatment of:
Trauma, both single incident, and long-term
Grief and loss
Anxieties and phobias
You can watch this short video by Bruce Hersey on an overview of EMDR
The following clip on YouTube provides a glimpse of the format and process of an EMDR session, in addition to the emotional catharsis and resolution that can take place:
Questions and Answers with Dr. Francine Shapiro, the creator of EMDR
EMDR and Post-Traumatic Stress Disorder Question: Please explain the mechanics of how P.T.S.D. occurs and why. Why is it some soldiers end up with P.T.S.D.? Why is it that not everyone raped gets P.T.S.D.? Dr. Shapiro responds: Post-traumatic stress disorder, or P.T.S.D., occurs when an experience is so disturbing that it disrupts the information processing system of the brain. This system has as one of its main functions the transformation of disturbing experiences into mental adaptation. That is, it takes a disturbing event and processes it in such a way that appropriate neural connections are made within the memory networks, which eliminate those aspects of the event (for example, negative thoughts, unpleasant emotions and physical sensations) that are no longer useful.
Sometimes, however, the event is so disturbing that the system is unable to perform these natural functions. The result is that the memory of the incident is stored along with the psychological and physical aspects of the event, including the negative beliefs that it engendered. Such an unprocessed traumatic memory may be stimulated by a current experience, and the encoded negative emotions, thoughts and sensations can emerge and color the perception of the present.
The reason that some people are affected more than others depends on genetics, the intensity of the experience, length of exposure and earlier life experiences. Some people have had positive experiences that contribute to greater resilience. Others have had negative experiences that can make them susceptible to later problems. For instance, an official diagnosis of P.T.S.D. requires that the individual experience a major trauma, like a rape, accident or battlefield experience. However, recent research indicates that in many cases, P.T.S.D. symptoms can occur as the result of less dramatic events. Some examples are hurtful childhood experiences with parents and peers, which can have a very negative effect on a person’s sense of self-worth. These events can set the groundwork for a wide range of symptoms, including a vulnerability to P.T.S.D.
EMDR and REM Sleep Question: Please explain the process of R.E.M. and E.M.D.R.
Dr. Shapiro responds: A Harvard researcher has suggested that the eye movements used in E.M.D.R. seem to stimulate the same processes that exist in rapid eye movement, or R.E.M., sleep. R.E.M. occurs in the same stage of sleep as dreaming, and during this time, scientists believe, the brain processes survival information. The implication is that, like R.E.M. sleep, the eye movements of E.M.D.R. facilitate the transfer of episodic memory, which includes emotions, physical sensations and beliefs associated with the original event, into semantic memory networks, in which the meaning of the event has been extracted and negative associations are no longer present.
The proposed link between E.M.D.R. eye movements and R.E.M. sleep has now been the subject of about a dozen randomized studies. Supporting the hypothesis were findings that E.M.D.R. eye movements decrease physiological arousal, increase episodic associations and increase the recognition of true information. Despite these results, many questions remain about the underlying mechanism for the effects of E.M.D.R. This is not a unique situation, however, since the neurobiological explanation for any form of therapy, and even many pharmaceuticals, remains obscure. In addition, see my earlier post, “The Evidence on E.M.D.R.,” for information about studies on E.M.D.R. and R.E.M.
How EMDR Is Done Question: Will you articulate to me and to the people here how you describe the E.M.D.R. process and protocol?
Dr. Shapiro responds: The eight phases of E.M.D.R. therapy begin with history taking, in which the presenting problems and early clinically significant life events are identified, and goals for the client’s fulfilling future set. The next phase involves preparing the client for memory processing. During processing, the client is directed to attend briefly to certain aspects of the memory while the information processing system is simultaneously stimulated. During this phase, the client engages in periodic sets of eye movements (sometimes taps or tones) for approximately 30 seconds each. It is during this time that the process of transforming the “stuck memory” into a learning experience and an adaptive resolution is observed. New and useful emotions, thoughts and memories emerge, and old and counterproductive ones are resolved. For example, the feelings of shame and fear voiced by a rape victim at the beginning of an E.M.D.R. session may be replaced by the feeling that she is a strong and resilient woman. E.M.D.R. therapy specifically addresses issues involving the past, present and future.
EMDR vs. Other Therapies for Trauma Question: How is E.M.D.R. different from other kinds of therapies for trauma victims?
Dr. Shapiro responds: Besides E.M.D.R. therapy, very few trauma treatments have a strong empirical basis. Two others that are well known are prolonged exposure therapy and cognitive processing therapy. Both are forms of trauma-focused cognitive behavior therapy, which require clients to describe in great detail their traumatic memory.
In prolonged exposure therapy, clients must describe the memory as if it were happening to them in the present. They repeat this two to three times during the session while an audio recording is made. The rationale for this form of treatment is that the reason clients’ problems persist is that they are avoiding reminders of the instigating events. Therefore, it is considered important for them to learn firsthand that they can experience the distress without being overwhelmed. Likewise, they are required to do daily homework between sessions that consists of listening to the recordings of their description of the event and visiting locations associated with it, to cause the disturbance to dissipate.
In cognitive processing therapy, clients are asked to provide details about the traumatic event so that their negative beliefs can be identified and then challenged and changed. This occurs during sessions and by doing daily homework assignments. In contrast to the preceding treatments, the emphasis in E.M.D.R. is to help the information processing system make the automatic connections required to resolve the disturbance. Specific procedures are used to help clients maintain a sense of control during memory work as the therapist guides their focus of attention. They need only focus briefly on the disturbing memory during the processing while engaged in the bilateral stimulation (eye movements, taps or tones) as the internal associations are made. The client’s brain makes the needed links as new emotions, sensations, beliefs and memories emerge. All the work is done during the therapy sessions. It is not necessary for the client to describe the memory in detail, and no homework is used.
E.M.D.R. and Childhood Trauma Question: I sought out an E.M.D.R. practitioner for the lifelong problems I’ve had from having rejecting, abusive parents. Do you agree that E.M.D.R. isn’t a good choice for someone like me? What do you suggest for someone with a difficult history like mine, who has been chronically anxious since very early childhood?
Question: Why do some think E.M.D.R. isn’t helpful with childhood trauma? From what my therapist told me, it sounds like it is often used with individuals with issues stemming from childhood. Isn’t that the point? But in the past I’ve heard that it may not be indicated for P.T.S.D. related to chronic trauma over a period of years, particularly when the trauma was sustained in childhood. Is that true? If so, why or why not?
Question: Have there been changes in your E.M.D.R. methods over the years to address some of the questions being raised in this forum — specifically for treatment of people with complex trauma (multiple traumas) and childhood traumas like sexual abuse or neglect?
Dr. Shapiro responds: E.M.D.R. therapy is widely used to treat chronic childhood trauma survivors. However, with this presenting problem, it often takes longer than with adult trauma victims for the client to feel secure and safe enough to do memory processing. Further, because of the larger number of events and earlier onset for childhood trauma victims, the processing work itself generally takes longer.
As I noted above, E.M.D.R. therapy is an eight-phase approach. The first two of these phases — history-taking and preparation — need to be more extensive with multiply traumatized survivors of childhood abuse than with adult trauma survivors. Stabilization and the development of skills and self-capacities, like the ability to self-soothe and tolerate emotions, are the primary focus in the preparation phase of E.M.D.R. treatment. There are often fears related to emotion and connections with others that must be addressed during the early phase of treatment before a survivor is able to move into work that focuses on the past.
E.M.D.R. therapy targets the way in which memories are stored in the brain. These include “takeaway” messages, like “I’m not good enough,” “It’s not O.K. to ask for what I want” and “I’m powerless to protect myself.” These feelings and beliefs are based on the child’s perceptions at the time of the experiences, whether they involved a major traumatic event like the loss of a parent to death or divorce, or something less dramatic but more insidious, like a daily diet of criticism or fear that something bad is going to happen.
The amount of exposure to bad experiences affects the development of symptoms. In general, the more severe and longer the exposure and the younger the age at exposure, the greater the impact will be in the form of pervasive and debilitating symptoms. Not always, but often, the amount of time needed for therapy also depends on whether the person has had any positive role models and significant figures who were supportive and nurturing. When these have been lacking, more time will generally be needed for preparation and comprehensive treatment. For some clients, this process will take longer because they have more negative experiences to process. For others, more stand-alone experiences occurred that changed the course of their lives. And, of course, there’s everyone in between.
These childhood traumatic memories and the pain and symptoms associated with them can be systematically reprocessed over time with E.M.D.R. The bottom line is that given an opportunity, the information processing system of the brain will move toward health.
E.M.D.R. therapy is used extensively in the treatment of chronic victimization and childhood traumatization. In fact, a study conducted by a large H.M.O. reported that within 12 sessions, 77 percent of multiple trauma victims treated with E.M.D.R. lost the diagnosis of post-traumatic stress disorder (Marcus et al., 1997, 2004). Another study with adult survivors of childhood sexual abuse also found it to be effective (Edmond et al., 1999, 2004). Both adult and childhood abuse survivors are represented in most studies that involve participants with mixed forms of trauma, and 20 randomized studies have found E.M.D.R. therapy to be effective in the treatment of P.T.S.D.
However, as mentioned above, the amount of treatment needed will vary depending on the type of trauma and how pervasive it was during childhood. For instance, one study compared eight sessions of E.M.D.R. therapy with eight weeks of Prozac with multiply traumatized adults. It reported that after treatment, 100 percent of adult-onset participants treated with E.M.D.R. no longer received a P.T.S.D. diagnosis, and 75 percent of the childhood-onset E.M.D.R. participants no longer had that diagnosis. But losing a P.T.S.D. diagnosis is only part of the story; at the six-month follow-up, the E.M.D.R. group continued to improve, while the Prozac group became more symptomatic. At that point, 75 percent of the participants treated with E.M.D.R. who were traumatized as adults were symptom-free, compared with 33.3 percent of the E.M.D.R.-treated group traumatized in childhood; everyone in the Prozac group continued to be symptomatic.
In clinical practice it is to be expected that more than eight sessions will be needed for successful treatment of childhood abuse, as comprehensive E.M.D.R. therapy addresses the entire clinical picture. The goal is not only to remove symptoms, but also to bring clients to full emotional health and fulfillment, both individually and in their personal relationships. Initial results from research under way reveal positive effects after approximately 24 sessions for those suffering from severe childhood abuse. These results support clinical observations that although many victims of childhood trauma will need comprehensive E.M.D.R. therapy, significant benefit can be observed within a few months after starting memory processing. It’s also worth noting that once processing begins, it is unnecessary to address each and every memory; treatment effects will generalize from a given memory to other similar events.
In all cases, a three-pronged approach should be used that addresses earlier experiences of abuse, current situations that trigger disturbance, and the skills and education necessary to ensure that the person is not only symptom-free, but able to flourish and thrive in the world. When someone has had an extremely difficult childhood that includes neglect or abuse, it is important to interview prospective clinicians to find someone who is experienced and well trained in phase-oriented trauma treatment for chronic childhood abuse and the use of E.M.D.R. therapy. Ideally, the clinician chosen will also be someone who stays informed with regard to the newest developments in treatment.
E.M.D.R. and Anxiety Question: My teenage son has had E.M.D.R. therapy for anxiety attacks that were very limiting in his ability to progress (go for job interviews, attend college classes that were intimidating to him). After a period of time here he seemed to improve, he stopped going to therapy and said he felt only life experiences would help him overcome some of his anxieties. After not seeing a therapist for a year, he told me today that he thought he needed to return. Is this a common result? Are patients ever “cured” through E.M.D.R. therapy, or will some patients need recurrent therapy throughout their lives?
Dr. Shapiro Responds: I believe the problem here is that your son terminated therapy prematurely. Some clients stop because they feel better and then want to do the rest on their own. However, the full protocol for E.M.D.R. treatment involves (1) processing the memories that set the foundation for the problem, (2) processing the current situations that trigger disturbance and (3) incorporating the experiences into the memory networks that are necessary to overcome skill or developmental deficits.
With longstanding anxieties, this would involve venturing out and noticing any new anxieties that arise. These would be addressed with further processing, since some anxiety responses are not revealed within the confines of the therapy session alone. For stable treatment effects, your son should address his various anxiety issues using this full application of E.M.D.R. therapy.
Long-Ago Trauma? Question: Is E.M.D.R. effective even if the event took place 15 years ago?
Dr. Shapiro responds: Yes, E.M.D.R. is effective regardless of the time since the event. The unprocessed memory remains stored in the brain. However, it can be accessed and successfully processed.
A year ago, an 80-year-old survivor of World War II asked her clinician to contact me. She had lived through numerous traumas during the war in Japan (bombing, rape, losing her mother and father) and had lived a life of “quiet desperation.” However, recently she had become severely dysfunctional because her husband had developed a hearing problem, and his shouting and playing the TV at a loud volume were bringing back reactions that emerged out of the chaos of the war years. This inability to cope any longer is often what brings people into therapy. After the traumas were processed, she told her clinician, “I feel free for the first time in my life.” Even at 80, her brain was able to “digest” and store appropriately the unprocessed information that had been embedded for the past seven decades. It’s never too late.
Stored Memories and E.M.D.R. Question: You write: “Many people feel that something is holding them back in life, causing them to think, feel and behave in ways that don’t serve them. E.M.D.R. therapy is used to identify and process the encoded memories of life experiences that underlie people’s clinical complaints.” In my experience this feeling of being held back is common to people in general, not just those who have experienced a traumatic event.
Question: Can E.M.D.R. be helpful even if people don’t remember specifically the traumatic event (example: abuse as an infant)? Or helpful to people who have had a traumatic event and remember it but do not necessarily associate it as being traumatic?
Dr. Shapiro responds: Recent research indicates that general life experiences can actually cause even more post-traumatic stress disorder symptoms than major trauma. In fact, our memory networks are the foundation of most clinical complaints. While genetic defects or organic insults, like those caused by injuries or toxins, can certainly contribute to dysfunction, research indicates that life experiences are also generally involved. Childhood humiliations, rejections, disappointment, bullying by peers, insensitive actions by authority figures and parental fights can be so disturbing that they disrupt the brain’s information processing system. The experiences then become stored as unprocessed memories and set the groundwork for later dysfunction. These stored memories include the emotions, physical sensations and beliefs that were experienced at the time of the original event. When something happens in the present, it can trigger this memory and shape our current perceptions and actions.
In E.M.D.R. therapy, we use specific techniques to help identify the memories that underlie the problems so they can be processed. At other times, by focusing on the present disturbance during processing, the earlier event will automatically emerge because of the associations in the memory networks. If the event took place too early in life for it to be encoded with a visual image, implicit memory processing still occurs, as evidenced by the elimination of the symptoms. So, regardless of the events in the person’s history or how he or she currently views them, E.M.D.R. therapy can be useful as the appropriate connections are made during the information processing sessions.
False Memories and E.M.D.R. Question: As a therapist, I work with a number of patients who were abused as children. As such they may have also created false memories in this process. How useful would E.M.D.R. be as treatment for them?
Question: Can E.M.D.R. prompt memories of past trauma to emerge? Can E.M.D.R. cause the creation of false memories?
Dr. Shapiro responds: All memory is fallible. During E.M.D.R. memory processing, associated memories may arise, but as with any form of therapy, there is no assumption without corroboration that they are true.
For instance, one of my clients came to me claiming that she had been raped by the devil when she was a child. During processing, she recognized that it was someone in a Halloween costume. However, if the memory had emerged on its own during processing, there would have been no assumption that it had actually been the devil.
Likewise, another client entered therapy concerned that perhaps her father had molested her, because she felt herself being held down and saw his face. During memory processing she remembered being attacked in a barn by some adolescents, and her father had come in to rescue her. She realized that this was the image of her father that she had been remembering. She was able to corroborate that this event had actually happened by asking her mother about it. Many “false memories” can be created throughout childhood by a variety of causes. In addition to abuse, children may hear a story or see something on TV and come to believe it happened to them. These vicarious experiences may then be stored accordingly.
Processing during E.M.D.R. therapy can allow these images to dissolve as the brain makes the appropriate connections. In talk therapy, false memories can sometimes be created through the inadvertent suggestions of the therapist, but this is unlikely in E.M.D.R. therapy because the clinical input is minimal while the client’s brain makes the appropriate internal connections.
Some of the randomized controlled research conducted on the eye movement component of E.M.D.R. has also indicated that it causes an increased recognition of positive information, and an increased accurate assessment of false information. Further research will determine to what degree these findings also enter into the memory processing outcomes.
E.M.D.R. in Children Question: What kind of results have been found using E.M.D.R. in children? Is it as effective/can it be tolerated?
Dr. Shapiro responds: E.M.D.R. therapy is widely used with children. It is designated as an effective treatment for trauma and considered “Well-Supported by Research Evidence” by the California Evidence-Based Clearinghouse for Child Welfare. Numerous studies with children have demonstrated that E.M.D.R. therapy is effective in reducing P.T.S.D. symptoms, as well as behavioral and self-esteem problems.
E.M.D.R. therapy is tolerated well by children, and positive results are often more quickly obtained than with adults because there are fewer memories to deal with. Although E.M.D.R. therapy entails specific, well-delineated procedures and steps, they are tailored to the needs of each individual. Therefore, playful and child-friendly strategies are used to make E.M.D.R. therapy developmentally appropriate and appealing for children.
Each child in E.M.D.R. therapy is seen as an individual with distinctive needs and assets. Each will need different levels of preparation before the traumatic memories that lie at the core of their suffering can be processed. The amount of time needed will vary depending on the level of traumatization, internal resources and external support available. The well-trained E.M.D.R. clinician will be able to assess how extensive the preparation should be for each child. As a result, when E.M.D.R. therapy is done appropriately, children will arrive at the moment of accessing and processing trauma memories with the proper psychological resources and abilities.
When possible, it is best to process disturbing experiences in childhood to prevent years of unnecessary suffering. These early traumatic and adverse experiences can have a profound and toxic affect on the child’s learning capacity, self-esteem and ability to form healthy and fulfilling relationships in the future. Aggressiveness, oppositional behaviors, school failure, anger outbursts, social isolation and the like may be some of the manifestations of past experiences that remain unprocessed in the child’s brain and continue to be activated by daily life triggers.
The ultimate goal of E.M.D.R. therapy is to tap into the child’s own information processing system so these memories of trauma and adversity can be processed and integrated. As a result, children can be free to respond to life’s demands with a healthy and age-appropriate sense of self, power and responsibility so they can follow a path to successful and rewarding lives.
Grief and E.M.D.R. Question: Has E.M.D.R. been successful in treating P.T.S.D. or complicated grief from loss of a child from suicide?
Dr. Shapiro responds: With the sudden loss of a child from any cause, a parent can be troubled by intrusive thoughts and images. Many times these include images of the deceased in pain, or the scene of death — real or imagined. The negative emotions can often involve feelings of sorrow about things the grieving person now wishes he or she could have done, or guilt about mistakes or things not done. These feelings can be overwhelming. In addition, people are often unable to remember the person at all without the intrusion of such thoughts and imagery.
E.M.D.R. therapy has been very successful in addressing these grief-related issues. In a multi-site study published in the journal Research on Social Work Practice, E.M.D.R. significantly reduced symptoms more often than cognitive behavior therapy on behavioral measures, and on four of five psychosocial measures. E.M.D.R. was more efficient, inducing change at an earlier stage and requiring fewer sessions. After treatment, those who had received E.M.D.R. could remember the deceased in a positive way, without the negative emotions. The heartfelt connection was still there, but without the pain.
Treating War Trauma With E.M.D.R Question: When I was an internist at the most highly academically affiliated Veterans Affairs hospital in the country, I asked a clinical psychologist with whom I worked whether E.M.D.R. would be applicable to some of my patients, and I was told that there was reluctance to use it because it had been tried in some Vietnam veterans and had elicited emotions that neither the patient or the therapist could control without untoward outcomes. What are your ways of getting around this experience, and why does it happen? Question: Could you talk about E.M.D.R. as a way to treat combat and war trauma?
Dr. Shapiro responds: E.M.D.R. is an eight-phase therapy approach. The second phase is preparation, which includes teaching clients a range of emotional state change techniques so that when memory processing begins they can control the feelings that may emerge during sessions, and allow them to return to “neutral” if they desire. The preparation is also important so that the techniques can be used to deal with any negative emotional responses that arise between sessions. For a detailed description see my recently published book “Getting Past Your Past.” The self-control techniques provide clients with a sense of self-mastery. Without the ability to feel and be in control of the therapy process, “untoward outcomes” can occur with any form of trauma treatment.
When E.M.D.R. therapy is performed appropriately, it is well tolerated by combat veterans. For instance, a randomized study of Vietnam veterans conducted at a V.A. medical center reported that after 12 sessions, 77 percent of them no longer had post-traumatic stress disorder. Importantly, none of the veterans dropped out of the study, which means that the therapy was well tolerated by all those who participated.
As mentioned in my post “The Evidence on E.M.D.R.,” other research with combat veterans has been faulted for insufficient treatment doses and/or faulty application. For instance, in some research, only one memory was treated with the multiply traumatized combat veterans and/or only two sessions were administered. Clearly, this is an insufficient time for both preparation and adequate processing for this population.
The most recent recommendation for the E.M.D.R. treatment of combat veterans is to use approximately 12 sessions, including at least one session of preparation. When the veteran has mastered the self-control techniques, it is appropriate to proceed with processing.
E.M.D.R. therapy has been used extensively with combat veterans and, as described in an article by the Department of Veterans Affairs and Department of Defense clinicians in The Journal of Clinical Psychology, it has a variety of advantages for veterans. While other forms of trauma treatments need detailed descriptions of the event by the client, this is unnecessary in E.M.D.R. Therefore, the veteran can be effectively treated even if he or she chooses not to discuss the event for any reason, including that it is classified information.
Not needing to speak in detail has also been reported to make the therapy easier for those with traumatic brain injury. In addition, unlike other trauma treatments, there is no homework, which is why it is being employed in combat situations. Further, physical symptoms such as pain and unexplained medical symptoms remit along with the trauma symptoms and emotions that are often most troubling to veterans.
As reported in the article: Combat veterans with P.T.S.D. may report large amounts of survivor guilt, perpetrator guilt, grief and anger. [E.M.D.R.] generally has no more difficulty with these emotions than any other emotion, or cognitions, or physical sensations. Indeed, E.M.D.R. has been found to reduce symptoms of mourning on behavioral and psychosocial measures in a multisite study…. For veterans, this translates into the ability to access positive memories of the dead where once they may have feared that reduction of their grief might equate to a loss of the memories of the dead…. E.M.D.R. provides rapid encouragement to remain in treatment by often providing symptom relief in the first or second session of desensitization. The client-centered nature of E.M.D.R. is empowering while not requiring details of the event, sustained disturbance or focus on the event, homework, or other tasks. This is particularly salient, as veterans in crisis may not be able to complete in vivo exposure or homework. Finally, E.M.D.R. encourages the resolution of disturbances manifested physically, emotionally, and cognitively, and does so even when the disturbance is generated from several different experiences. For war veterans whose traumatic events are usually multiple, this is an effective tool.
Since E.M.D.R. therapy is not available in all V.A. facilities, the E.M.D.R. Humanitarian Assistance Programs, our nonprofit group, has made arrangements for free treatment for combat veterans in certain locations. Because E.M.D.R. therapy does not require homework to be effective, it can be provided on consecutive days. In fact, some programs now provide morning and afternoon sessions, which can allow treatment to be completed within a week.
Peak Performance and E.M.D.R. Question: Dr. Shapiro, you wrote that your book “Getting Past Your Past” includes techniques “taught to Olympic athletes to achieve peak performance. These can also help people prepare for challenges like presentations, job interviews and social situations.” What’s the relationship between sports performance and job interviews or social situations, and what does it have to do with E.M.D.R. therapy?
Dr. Shapiro responds: Dr. Shapiro responds: People seek therapy for a variety of reasons, but in general the reasons can be summarized as being “stuck” and prevented from acting in ways that are healthy and adaptive. E.M.D.R. therapy is used to process the memories of experiences that set the foundation for the problems, process the current situations that cause disturbance and trigger negative behaviors, and incorporate the skills needed to achieve positive outcomes in the future. For those interested in achieving “peak performance” in sports, the person’s history is examined to identify what memories may be blocking them from achieving their goals. Often this turns out to be previous failures, injuries and negative comments by coaches or peers. These memories remained stored in the brain with the negative emotions, beliefs and body reactions that occurred at the time of the event.
For instance, as I describe in “Getting Past Your Past”: Kyle was a top state-ranked high school athlete who came to therapy to work on his lack of confidence and motivation. He processed memories of injuries and distractions such as imposing opponents, parental comments and disappointing looks on his coach’s face. A number of techniques [in the book] were used to help him stay focused on the game. Upon graduation, Kyle received a scholarship to attend a prominent university as part of their NCAA Division I highly ranked team. As he said, “This doesn’t just help with my sport, does it? I’m getting straight A ’s for the first time!” He’d attended an academically challenging parochial school and had been struggling with learning disabilities.
Some of the techniques taught in the book involve ways to achieve a state of calm and confidence. Many people mistakenly believe that it is important to feel anxious in order to perform well. However, performance research demonstrates that while “arousal” is involved, the way we deal with the arousal makes the difference between success and failure. Therefore, performers, executives and athletes are taught ways to achieve optimal emotional and physical states. In addition, E.M.D.R. therapy incorporates “positive memory templates” that set the stage for positive performance in the future. A survey of Olympic athletes and coaches reported that 90 percent of the athletes and 94 percent of the coaches incorporated these kinds of imagery techniques into their training programs.
So whether your desired “peak performance” involves athletics, executive functioning, social interactions or optimizing a job interview and social interactions, you can utilize these techniques to prepare yourself to do your best.
How Long do People Need E.M.D.R.? Question: I received E.M.D.R. for longstanding issues from childhood after so many other types of therapies had been unsuccessful. While previous (non-E.M.D.R.) counselors taught me how to counteract negative thoughts and gave me tools to use when things upset me, following E.M.D.R. therapy I simply don’t slide into those negative thoughts and feelings in the first place. I find it easy now to care for myself in more healthy ways, and I don’t get blown out of the water by daily challenges as I used to. The results of E.M.D.R. have been really dramatic; and did not require the amount of time that other types of therapy were requiring. I guess I just wonder if my experience was typical. Is there actually any research on how long people need E.M.D.R. therapy compared to other types of therapy?
Dr. Shapiro responds: There is research supporting your experience that E.M.D.R. therapy can be completed rapidly. There are two randomized studies reporting 84 percent to 100 percent of single-trauma victims no longer had P.T.S.D. after three 90-minute treatment sessions. In addition, a study funded by Kaiser Permanente indicated that within an average of six 50-minute sessions, 100 percent of the single-trauma victims and 77 percent of the multiple-trauma victims no longer had P.T.S.D.
Each form of therapy is guided by a different theory of practice and contains different procedures. E.M.D.R. therapy and two forms of trauma focused-cognitive behavioral therapy (C.B.T.) have the most research support and are considered “A” level treatments by organizations such as the Department of Defense. There are many differences between the treatments, including the procedures considered necessary to achieve positive effects. The C.B.T. treatments focus on challenging negative beliefs and behaviors, both during sessions and with daily homework. E.M.D.R. therapy, on the other hand, focuses on processing the memories so that associations spontaneously arise as learning takes place. No treatment homework is assigned.
There are now 10 randomized studies comparing C.B.T. and E.M.D.R. therapy. In seven of the 10 studies, E.M.D.R. therapy had superior outcomes on at least some measures and/or was more efficient, using fewer sessions in five of the seven studies (Arabia et al., 2011; de Roos et al., 2011; Ironson et al., 2002; Jaberghaderi et al., 2004; Lee et al., 2002; Nijdam et al., 2012; Power et al., 2002). The other three studies (and four of the ones just mentioned) all used daily homework in the C.B.T. condition compared to none in the E.M.D.R. condition (Rothbaum et al., 2005; Taylor et al., 2003; Vaughan et al., 1994). The Taylor study is the only one that found C.B.T. superior on some measures, and it used both imaginal and therapist-assisted in vivo exposure (where the client goes to a feared location) during half the sessions, plus an additional 50 hours of homework.
The bottom line is that E.M.D.R. therapy generally appears to be more rapid and does not use homework to achieve positive effects. As you discovered, the negative thoughts and feelings disappear once the memories are processed. In addition, your quality of life improves as you view yourself and life’s challenges in a different way.
E.M.D.R. and the Brain Question: I have little knowledge of the controversies behind it; is it because it is still relatively new? What parts of the brain are highlighted during this therapy?
My observation is this: to lay people, connecting eye movement to trauma and treatment sounds wacky, almost a hoax. I suspect that this may be, in part, why E.M.D.R. is not better known; it sounds too unbelievable. Are there any plans for a public information campaign by credible sources so that more people can be helped? What are the roadblocks to this? Dr. Shapiro responds: The controversy regarding E.M.D.R. therapy stems from misinformation. When it was first introduced in 1989, the use of eye movements did seem strange to many people, and unfortunately the early research examining that component did not show positive effects. In 2000, a committee of the International Society for Traumatic Stress Studies (ISTSS) criticized all the previous research on the eye movement component as being poorly done. However, many people remain influenced by those discredited initial research reports.
Critics are also generally unaware that in the past 10 years more than 20 new randomized studies have demonstrated positive effects for the eye movement, including immediate declines in negative emotions. At this point, most major organizations, such as the American Psychiatric Association, ISTSS and the DVA/DoD, recommend E.M.D.R. as a treatment for trauma. Consequently, few people argue that E.M.D.R. therapy is not effective, but others say it is controversial because “no one knows for sure why it works.” However, that is true of all forms of psychotherapy and most pharmaceuticals. Others claim E.M.D.R. therapy is no different than traditional C.B.T. However, as I described above, there are indeed major differences between the treatments, including the fact that E.M.D.R. therapy does not need the one to two hours of daily homework used in C.B.T. trauma treatments to achieve positive effects.
Unfortunately, articles on the Internet continue to fan controversy by circulating outdated criticism and other misinformation. Therefore, the best public information campaign is for those people who have had positive experiences, and know the actual facts, to let others know about it. As for your question regarding the brain, there are about a dozen neuroimaging studies with a range of findings summarized in an article by Bergmann.
Pre/Post evaluations of E.M.D.R. therapy have reported left frontal lobe activation, decreased occipital activation and decreased temporal lobe activation. These findings are indicative of (a) emotional regulation due to increased activity of the prefrontal lobe, (b) inhibition of limbic over-stimulation by increased regulation of the association cortex, (c) reduction in the intrusion and over-consolidation of traumatic episodic memory due to the reduction of temporal lobe activity, (d) the reduction of occipitally mediated flashbacks, and (e) the induction of a functional balance between the limbic and prefrontal areas.
Recent modifications in neuroimaging paradigms have illustrated findings of bilateral dorsolateral prefrontal activation, as well as left orbitofrontal and right ventromedial prefrontal activation. The implications of these findings have yet to be fully understood, but suggest repair in memory function, working memory/concentration, and affect regulation, respectively. In addition, the finding of increased thalamic activation following successful E.M.D.R. treatment was noted for the first time. The consequence of such a change suggests the repair of failures in cognitive, memorial, affective, somatosensory, and interhemispheric integration, which are disrupted in P.T.S.D.
Similarly, consistencies have been seen in psychophysiological studies, manifested by findings of parasympathetic relaxation responses, increased heart rate variability parasympathetic tone, reduced electrodermal function, reduced EEG P3a function, and increased vagal parasympathetic function. These findings suggest that E.M.D.R. affects the affect regulatory systems, inducing an initial “compelling” parasympathetic state change that facilitates information processing and neural linkage repair and the eventual stable trait change that is seen as a result of successful E.M.D.R. treatment.
Breathing and E.M.D.R. Question: I'm curious about the relationship of intentional, lateral eye movements and changes both in the psoas and diaphragm. Obviously both of these soft tissue structures are involved in traumatic responses. But why is it that, when I intentionally shift my eyes laterally, my breathing softens & deepens rather than being triggered into a panic response?
Dr. Shapiro responds: There are approximately 10 randomized studies that have investigated the hypothesis that the lateral eye movements cause relaxation because of a so-called orienting response, or O.R. All the studies have documented a decrease in negative emotion and arousal. When an animal in the wild is startled because of sudden movement it reflexively shifts its eyes to investigate. When safety is noted, the animal relaxes. This compelled O.R. response is parasympathetic, habituating and geared toward information processing. The O.R. is differentiated from the startle response (S.R.) and defensive response (D.R.), both of which are sympathetic, sensitizing and geared toward action, rather than information processing. Research has identified both the relaxation response and the retrieval of information during the sets of eye movements used in E.M.D.R. therapy. In clinical practice, clients report that new associations are made, indicating that learning is taking place.